SU1690701A1 - Method for peritonitis treatment - Google Patents

Abstract

The invention relates to medicine, in particular to abdominal surgery, and can be used for the treatment of acute peritonitis. The aim of the invention is to prevent complications and reduce the duration of treatment. This goal is achieved by producing a mechanical washing of the abdominal cavity with 1.5-2 liters of polyionic solutions in a flow-through mode for 10-15 minutes, and then oxygenated polyionic solutions with antibiotics in a dose of 2.5-3 liters are introduced into the abdominal cavity. 3-4 hours, 3-4 times a day.

Description

The invention relates to medicine, in particular to abdominal surgery and can be used to treat acute peritonitis.

The aim of the invention is to prevent complications and reduce the duration of treatment.

The method is illustrated by the following example.

Example. Patient K.S., 24 years old, was admitted to the hospital with a diagnosis of acute diffuse peritonitis.

After the operation, infusion- and antibacterial therapy (tetrolen, lincomycin IV) was immediately started. Four hours after the operation, oxygenated peritoneal dialysis was started using the proposed method. Ringer was used as dialysate. In 1 day, an additional 0.05% solution of chlorhexidine digluconate in 40 ml was added. Dialysate was oxygenated in an oxygenator under a pressure of 750 mmHg. Art. within 45 min. The first portion of the oxygenated solution in a volume of 1.5 liters was introduced into the abdominal cavity through the upper drainage jet

for 10-15 minutes, after which the dialysate was immediately removed. A second portion of the oxygenated solution (1.5 liters) with the addition of 80 mg of gentamicin was injected when the lower drains were squeezed in a jet into the upper drainage, which then overlapped. The partial pressure of oxygen in the solution is 77 mm Hg. Art. Exposure was 4 hours. During the exposure, active and passive movement of the internal organs was performed, after which the dialysate was removed. On the first day, the patient was on artificial lung ventilation, peritoneal dialysis was performed 4 times with an exposure of 4 hours. Dialysate dark muddy. Intensive therapy was carried out, as well as intestinal decompression with passive-active aspiration with monomer-electrolyte solutions in a volume of 3 liters.

. On the second day, the patient was transferred to spontaneous breathing, pharmacological stimulation of the intestines was initiated, and long-term epidural anesthesia was started. Enteral feeding of polymer-electrolyte solutions was carried out in a volume of 1 l and intestinal decompression.

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Peritoneal dialysis was carried out similarly, dialysate became clear. By the end of 2 days, peristalsis was weak and there was an independent liquid stool in the amount of 200 ml. For 3 and 4 days, peritoneal dialysis, taking into account the cleansing of dialysate, and the improvement of the express-bacterioscopy picture, was carried out 3 times with an exposure of 3 hours, the partial pressure of oxygen in the solution was 600 mm Hg. Art. By the end of 4 days, the dialysate was cleansed, light, transparent, on the express bacterioscopy, single gram-negative rods, tank were observed. Seeding exudates in aerobic and anaerobic conditions is sterile. In connection with this, peritoneal dialysis was discontinued and on the 5th day the drainage from the abdominal cavity was removed, the patient was transferred from the intensive care unit to the general surgery room. From tests on the 5th day: hemoglobin 100 g / l; erythrocytes 3,2х1012 / l, leukocytes

9.9x10 / l, urea 8.5 mmol / l, creatinine 127.5 μmol / l, total protein 64.2 g / l, on the 8th day, remove the stitches from the wound, healing is primary. The patient in a satisfactory condition was discharged home.

Claims (1)

The invention The method of treating peritonitis, including drainage of the abdominal cavity, conducting peritoneal dialysis through the flow-through introduction of polyionic solutions with antibiotics and oxygen, characterized in that, in order to prevent complications and shorten the treatment time, the abdominal cavity is washed with 1.5-2 liters polyionic solutions in flow-through mode for 10-15 minutes, and then oxygenated polyionic solutions with antibiotics in a dose of 2.5-3 liters for 3-4 h 3-4 times per day are introduced into the abdominal cavity.